LADA: Getting to know my new friend
EDITOR'S NOTE: May is the third anniversary of the GLOB Master being diagnosed as a diabetic. Mike Sanford's personal observations below of this continuing adventure is the first of three stories presented in the GLOB this week summarizing his never ending odyssey in search for the perfect blood sugar strategy. SPECIAL THANKS to GLOB Staffer Emeritus Lynn Dirk for her unique scientific editing assistance to this story.
This month the GLOB Master celebrates the third year of a diabetes diagnosis now identified as Latent Autoimmune Diabetes in Adults. (LADA). In the diabetes world, that means essentially I am now a Type 1 diabetic.
Talk about 'Happy Anniversary to Me'.
Diabetes, in general, is all about insulin and sugar:
Insulin is a hormone made by the pancreas that allows your body to use sugar (glucose) from carbohydrates in the food that you eat for energy or to store the sugar as glucose for future use. The cells in your body need sugar for energy. However, sugar cannot go into most of your cells directly. After you eat food and the sugar in your blood increases, cells in your pancreas (known as beta cells) are signaled to release insulin into your bloodstream. Insulin then attaches to and signals cells to absorb sugar from the bloodstream. Insulin is often described as a "key," which unlocks the cell to allow sugar to enter and be used for energy.
According to the American Diabetes Association, type I Diabetes, is all about Islet autoantibodies:
LADA is all about beta-cells: Despite the presence of islet antibodies when diabetes is diagnosed, failure of autoimmune β-cells continues to slowly progress. LADA patients therefore do not require insulin for at least the first 6 months after diagnosis. Among patients with phenotypic type 2 diabetes, LADA occurs in 10% of those older than 35 years and in 25% younger than that. Prospective studies of β-cell function show that LADA patients with multiple islet antibodies develop β-cell failure within 5 years.
One of the all-time great rock 'n roll lines is from the Grateful Dead's Truckin' where the band sings. "What a long strange trip it's been." This lyric fits my 36-month diabetes adventure perfectly.
Of course, I often think of the story, 'Lemony Snicket's Series of Unfortunate Events' after I fall down, shoot myself up with insulin, or get rolled into the UF/Shands Emergency Room.
Either reference mentioned above is a fine description of me the last year with hospital stays (ketoacidosis), falling down (diabetes dehydration events), or the constant roller coaster ride of trying to manage my volatile blood glucose level.
With a quintet of excellent UF Health medical team members diagnosing my diabetes symptoms for the last 16 months, my lack of improvement over the past year created a good amount of dismay regarding my: Falling down in the bathroom two consecutive Wednesday nights, fainting in front of UF's George Smathers Library on a Gator Game Day Saturday, and multiple dehydration events culminating in fainting in the Publix Grocery store line and rushed to the UF/Shands Emergency room. My inability to keep my blood sugar level normal created bad outcomes for this diabetic.
Enter 2019 and a new doctor in the UF Health Department of Endocrinology, and Dr.Juan M. Munoz-Pena, MD, who introduced me to time-release insulin, and a sliding scale process of managing my blood glucose level that appears to finally allow me to better control of Mike Sanford's diabetes world.
Thanks to Dr. Munoz-Pena introducing me to the insulin sliding scale dosage process I am now able to adjust my blood sugar in the morning, breakfast, lunch, and dinner, four or five times a day as needed. An upside to this daily monitoring is I am able to better keep my blood glucose closer to a satisfactory level all day and to avoid extreme spikes or lows that can be dangerous.
This radical – for me -- modification to my diabetes regimen immediately impacted my high A1c scores. I started the new program in February with an A1c of 14. By the first of April I had brought that very high number down 4 points to 10 on the A1c scale. I am excited about seeing my next 90-day A1c score in June.
For people with diabetes, the risk of dehydration is greater because higher than normal blood glucose depletes fluids. To get rid of the glucose, the kidneys try to pass it out in urine, but that takes water. So the higher your blood glucose, the more fluid you should drink, which is why thirst is one of the main symptoms of diabetes.
My diagnosis of LADA resulted from my pancreas no longer producing insulin. The explanation why the body needs insulin has taken on a whole new meaning for me:
Believe it or not there are some 'benefits' to this new, internal walk on the wild side:
I no longer feel like I am a spectator, patient, watching my body behave badly in its daily need for sustenance.
As good or as bad as it may seem, I do have comfort knowing that, my healthy exercise routine, trying to be a healthy eater, and now MY involvement in an ongoing insulin management process, I should not be surprised with any more life-threatening ketoacidosis events, I hope.
According to Dr. Munoz-Pena there are still, and always will be, minor adjustments to my new diagnosis/diabetes regimen and at this point:
- All oral agents where removed including Metformen and Glipizide.
- Insulin is now dosed appropriately and
- You are learning to dose more precisely based on carb consumption, or "carb counting".
- The GLOB Master needs to remember that you take a dose of insulin to cover your meals and the sliding scale is ADDED to correct for highs.
One of my favorite lines about my diabetes was, "If I had five diabetes outcomes a day, three of them were bad." I wouldn't say I have mastered my diabetes. I do now feel, however, like a player in the diabetes process. I am no longer an uninvolved spectator of what will be -- in my case – a continuing very long, strange, diabetes adventure.
PREVIOUS GAINESVILLE LUNCH OUT BLOG DIABETES STORIES:
FRIDAY: When is diabetes disclosure proper?